Effect Of TORCH Infection On Pregnancy And Neonatal Outcomes Of IVF/ICSI-ET In Patients With Spontaneous Abortion

Background:In China,the incidence rate of infertility is 7%-10%,and it is still increasing.Assisted reproductive technology is an effective treatment for people who are infertile.In vitro fertilisation-embryo transfer techniques and intrafollicular single sperm injection are important parts of assisted reproductive technology.The adverse pregnancy outcome after IVF/ICSI-ET treatment is a problem worthy of high attention in the field of reproductive medicine.Some studies have reported that the rate of spontaneous abortion in IVF/ISCI-ET population is higher than that in natural pregnancy population.There are many factors leading to spontaneous abortion,and the proportion of infectious factors is about 10%.Among them,TORCH infection is the main cause of spontaneous abortion and fetal and neonatal teratogenesis.Habitual abortion caused by TORCH infection is an indication for IVF/ISCI-ET.This study focused on patients treated with IVF/ICSI-ET with a history of spontaneous abortion and chose to investigate the impact of TORCH infection on pregnancy outcomes,which is still the subject of much controversy.Due to the specificity of the study population,attention was focused on the impact of TORCH infection on ovulation promotion and embryo outcomes in assisted reproductive populations.The safety of the offspring of assisted reproductive population is a hot topic of concern today,and people with a history of poor pregnancy should be the focus of attention.However,there is a lack of high-quality clinical data on the impact of acute and previous TORCH infection in infertile populations with a history of spontaneous abortion on patients treated with IVF/ICSI-ET in China.This study provides a reference for the prevention of spontaneous abortion and treatment options for IVF/ICSI-ET.Objectives:The aim of this study was to investigate the relationship between previous pregnancy outcomes and TORCH pathogen infection,to investigate the prevalence of TORCH infection in patients undergoing IVF/ICSI-ET with a history of spontaneous abortion,to discover the impact of previous TORCH infection on pregnancy outcomes and neonatal outcomes in spontaneously aborted patients undergoing IVF/ICSI-ET assisted conception,to investigate ways to increase the rate of positive herpes simplex virus DNA in cervical secretions,and to provide recommendations for the prevention of miscarriage due to TORCH infection factors in assisted reproduction populations.Methods:Infertile women who underwent IVF/ICSI-ET treatment in a third-class hospital in Jinan City,Shandong Province from January 1,2017 to December 31,2020 were selected as the research objects.Blood samples were collected by sterile venipentesis.The tests of cytomegalovirus,herpes simplex virus,rubella virus and toxoplasma were completed by the LIAISON fully automated chemiluminescence immune analyzer and the TORCH matching quality control products and reagents produced by DiaSorin in Italy.The samples of cervical secretions were collected by professional trained medical staff in the B-ultrasound room,and the specific DNA nucleic acid fragments of herpes simplex virus type 1 and herpes simplex virus type 2 were respectively detected by fluorescence PCR.General data of infertile women undergoing IVF/ICSI-ET treatment,including age,time of medical examination,residence address,education level and lifestyle,were collected by trained medical workers using standardized questionnaires.The previous pregnancy history and pregnancy outcome of infertile women who underwent IVF/ICSI-ET treatment were investigated,so as to obtain the information of pregnancy complications,birth date,birth length,birth weight and development of their offspring.Statistical analysis was performed using R software and SPSS21.0 software as main tools.Results:1.TORCH serum screening and pregnancy outcome analysis of infertile women undergoing IVF/ICSI-ETAfter PSM,the positive percentages of CMV-IgM,HSV-IgM and RV-IgM were higher in the miscarriage group than in the normal group,and the difference was considered statistically significant(P<0.05).After PSM,the positive percentages of TOX-IgM in the miscarriage group were not statistically significant when compared with the normal group(P>0.05);after PSM,the positive percentages of CMV-IgG,HSV-IgG,RV-IgG,and After PSM,there was no statistically significant difference between the positive percentages of CMV-IgG,HSV-IgG,RV-IgG and TOX-IgG in the abortion group and the normal group(P>0.05).After PSM,the positive percentages of CMV-IgM,HSV-IgM,RV-IgM and TOX-IgM in the preterm delivery group were not significantly different from those in the normal group(P>0.05).After PSM,there were no significant differences in the positive rates of CMV-IgG,HSV-IgG,RV-IgG,and TOX-IgG in the preterm group compared with the normal group(P>0.05).After PSM,the rates of CMV-IgM,HSV-IgM,RV-IgM and TOX-IgM positivity in the developmental abnormalities group were not statistically significant when compared with the normal group(P>0.05).After PSM,the rates of CMV-IgG,HSV-IgG,RV-IgG and TOX-IgG positivity in the developmental abnormalities group were not statistically significant when compared with the normal group(P>0.05).2.Investigation of TORCH infection in infertile women with a history of spontaneous abortion and undergoing IVF/ICSI-ET treatmentSerum TORCH-IgM test results were most positive for HSV and least positive for TOX.Serum TORCH-IgG test results were higher for CMV and HSV than for RV and TOX,and lowest for TOX.positivity for TORCH was not associated with the number of abortions.infection patterns were predominantly IgM-/IgG+for CMV,HSV and RV,and IgM-/IgG-for TOX,and were not associated with the number of abortions.TORCH There were differences in pathogens by age,region,and level of education.3.Effects of past TORCH infection on pregnancy and neonatal outcomes in women with a history of spontaneous abortion assisted by IVF/ICSI-ETA total of 2350 cycles were included,with 1175 cycles successfully transplanted and a cycle cancellation rate of 50%.There was no statistically significant difference between the TORCH-IgG(+)group and the TORCH-IgG(-)group in baseline data such as the age of the woman,the age of the man,the age of infertility,body mass index(BMI),and basal endocrine status(P>0.05).The number of follicles with a diameter of more than 14 mm,the number of retrieved eggs,the number of zygote,and the clinical pregnancy rate in the CMV IgG(+)group were lower than those in the CMV IgG(-)group;The abortion rate and early abortion rate in the CMV-IgG(+)group were higher than those in the CMV-IgG(-)group;There were no significant statistical differences between the CMV-IgG(+)group and the CMV-IgG(-)group in terms of normal fertilization rate,human chorionic gonadotropin(HCG)daily endometrial thickness(EMT),HCG daily estradiol(E2),HCG daily progesterone(P),number of transferred embryos,number of transferred embryos,live birth rate,preterm birth rate,and cesarean section rate.The number of fertilized eggs and clinical pregnancy rate were lower in the HSV-IgG(+)group than in the HSV-IgG(-)group;the early miscarriage rate was higher in the HSV-IgG(+)group than in the HSV-IgG(-)group;there was no statistically significant difference in the number of follicles over 14 mm in diameter,number of eggs obtained,normal fertilization rate,EMT on HCG day,E2 on HCG day,P on HCG day,number of embryos transferred and days of embryo transfer between the HS V-IgG(+)and HSV-IgG(-)groups.The number of follicles over 14 mm in diameter,the number of fertilized eggs and the clinical pregnancy rate were lower in the RV-IgG(+)group than in the RV-IgG(-)group;the miscarriage rate and early miscarriage rate were higher in the RV-IgG(+)group than in the RV-IgG(-)group;there was no statistically significant difference in the number of eggs obtained,normal fertilization rate,HCG day EMT,HCG day E2,HCG day P,number of embryos transferred,days of embryos transferred,live birth rate,preterm birth rate and cesarean section rate between the RV-IgG(+)and RV-IgG(-)groups.There was no statistically significant difference between the TOX-IgG(+)and TOX-IgG(-)groups in terms of the number of follicles over 14 mm in diameter,number of fertilized eggs,number of eggs obtained,normal fertilization rate,EMT on HCG day,E2 on HCG day,P on HCG day,number of embryos transferred,days of embryos transferred,clinical pregnancy rate,miscarriage rate,early miscarriage rate,live birth rate,preterm birth rate and caesarean section rate.There was no statistically significant difference between the TORCH-IgG(+)and TORCH-IgG(-)groups when comparing the incidence of gestational diabetes mellitus,hypertensive disorders of pregnancy,and fetal developmental abnormalities.4.Detection Results of HSV-1/2 IgM,HSV-1/2 DNA in Blood,and HSV-1/2 DNA in Vulva and Cervical SitesA total of 60 subjects were included in this experimental design.The positive rate of HSV-1 IgM in blood was significantly higher than that of HSV-2 IgM,with a statistically significant difference(P<0.05).The results of HSV-1 DNA and HSV-2 DNA in blood samples from different infection modes were negative.The results of HSV-1 DNA and HSV-2 DNA from vulva and cervical samples were negative.Among the 30 positive samples of cervical secretions,the positive rate of HSV-2 DNA was significantly higher than that of HSV-1 DNA,with a statistically significant difference(P<0.05).Conclusions:1.Infertile women with a history of spontaneous abortion who undergo IVF/ICSI-ET treatment are at high risk for TORCH infection.Detection of the pathogen of TORCH should be carried out as soon as possible to reduce the incidence of spontaneous abortion.2.The acute infection of TORCH in spontaneous abortion patients undergoing IVF/ICSI-ET treatment is mainly HSV,while previous infections are mainly CMV and HSV.Since 2017,the positive rate of HSV-IgM has been increasing year by year,and the prevention and control of HSV should be strengthened.There are differences in the age,region,and educational level of TORCH pathogens.3.Previous CMV,HSV and RV infections were associated with fetal and maternal outcomes in patients with a history of spontaneous abortion treated with IVF/ICSI-ET.Prior TOX infection was not associated with fetal or maternal outcomes in patients with a history of spontaneous abortion treated with IVF/ICSI-ET.4.Analyze the reasons for the differences between HSV-IgM in blood and HSV DNA in cervical secretions from the aspects of sample collection and transportation process,sample type,and sample collection site.To improve the detection rate of HSV DNA,it is recommended to collect cervical secretions when HSV-2 IgM is positive.